Previous Name

Title

Title is required.

First Name

Use your full first name. Do not use nicknames or initials.

Last Name

This field is required.

Suffix

optional

Street Address

Put your home address in these boxes. Do not put your mailing address here if it is different from your home address. Do not use a post office box or rural route without a box number. If you live in a rural area but do not have a street address, or if you have no address, please show where you live using the map on the printed form.

If you have moved since your last registration, enter your previous address.

Previous Zip Code

Enter a valid 5 digit zip code.

ID Number

You must provide your Florida driver's license number or non-operating identification license number. If you do not have a driver's license or non-operating identification number, you must provide the last four digits of your Social Security number. If you do not have any of these forms of identification, please enter "NONE" and a unique identifying number will be assigned by the state.

Birthdate

Enter your birthdate in MM/DD/YYYY format.

Email Address

Phone Number

Enter a phone number in xxx-xxx-xxxx format.

Type

Political Affiliation

You must register with a party if you want to take part in that party's primary election, caucus, or convention.

Race or Ethnic Group

The state of Florida requests information about your race or ethnicity. Your application will not be rejected if you fail to provide this information.